MEDICARE: LAURA EVANS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	201350043NP	OR
2	363LF0000X	Family Nurse Practitioner	1287	AK

General Provider Information

NPI Number	:	1245597459
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA EVANS

Provider Business Mailing Address
First Line	:	1389 HUFFMAN ROAD
Second Line	:	#150
City	:	ANCHORAGE
State	:	AK
Zip	:	99515
Country	:	US
Telephone Number	:	888-227-3312
Fax Number	:

Provider Business Practice Location Address
First Line	:	1455 NW IRVING ST STE 600
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97209-2277
Country	:	US
Telephone Number	:	844-966-6463
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/12/2012
Last Update Date	:	09/30/2020

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Directions to “ LAURA EVANS ” Practice Location

Language	Start Address	Practice Location

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